Pimozide

Pimozide is a prescription medication used to suppress the motor and phonic tics associated with Tourette's disorder. 

• Pimozide is available under the following different brand names: Orap

Adult and pediatric dosage

Tablets

• 1mg
• 2mg

Tourette Disorder

Adult dosage

• Initial 1-2 mg orally once a day; increase every other day; not to exceed 10 mg/day
• Maintenance: below 0.2 mg/kg/day or 10 mg/day, choose the  lowest dose 

Pediatric dosage

• Children below 2 years
  • Safety & efficacy not established
• Children 2-12 years
  • Initial: 0.05 mg/kg/day orally every night at bedtime 
  • Can be increased every 3 days  to 0.2 mg/kg/day orally every night at bedtime 
  • Maintenance dose: 2-4 mg/day; not to exceed 10 mg/day
• Children above 12 years
  • Initial 1-2 mg orally once a day; increase every other day; not to exceed 10 mg/day
  • Maintenance: below 0.2 mg/kg/day or 10 mg/day, choose the lowest dose

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Pimozide include:

• drowsiness,
• dizziness,
• dry mouth,
• blurred vision or other vision problems,
• tiredness,
• weakness,
• fever,
• headache,
• restlessness, or
• constipation.

Serious side effects of Pimozide include:

• muscle stiffness
• falling
• confusion
• sweating
• fast or irregular heartbeat
• neck cramps
• tightness in the throat
• difficulty breathing or swallowing
• a tongue that sticks out of the mouth
• fine, worm-like tongue movements
• uncontrollable, rhythmic face, mouth, or jaw movements

Rare side effects of Pimozide include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Pimozide has severe interactions with at least 94 other drugs.
• Pimozide has serious interactions with at least 128 other drugs.
• Pimozide has moderate interactions with at least 323 other drugs.
• Pimozide has minor interactions with at least 58 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Documented hypersensitivity
• CNS depression (including coma), neuroleptic malignant syndrome (NMS), poorly controlled seizure disorder
• Use as first-line treatment
• Tics not associated with Tourette's
• Prolongs QT interval: concurrent QT-prolonging drugs or congenital long QT patients
• Concomitant CYP3A4 or CYP2D6 inhibitors

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Pimozide?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Pimozide?”

Cautions

• FDA Warning regarding off-label use for dementia in elderly
• Avoid grapefruit juice
• Risk of EPS & NMS
• Leukopenia/neutropenia and agranulocytosis were reported; possible risk factors for leukopenia/neutropenia include pre-existing low white blood cell count (WBC) and history of drug-induced leukopenia/neutropenia
• If history of clinically significant low WBC or drug-induced leukopenia/neutropenia, monitor complete blood count (CBC) frequently during the first few months of therapy; discontinue the drug at the first sign of a clinically significant decline below 1000/mm³ in WBC in absence of other causative factors and continue monitoring WBC until recovery

Pregnancy & Lactation

• Use with caution if the benefits outweigh the risks during pregnancy.
• Neonates exposed to antipsychotic drugs during the 3rd trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery
• These complications vary in severity; in some cases, symptoms have been self-limited, while in other cases neonates have required intensive care unit support and prolonged hospitalization
• Lactation
  • Unknown, avoid